Emerging Therapeutic Strategies in Asthma: Advances in Treatment, Drug Delivery, Drug Adherence, and Disease Management.

purpose of reviewThis review synthesises evidence published between 2020 and 2025 on emerging therapeutic strategies for asthma, with a focus on three interrelated domains: targeted treatments across asthma endotypes, advances in drug delivery aimed at improving pulmonary deposition and therapeutic efficiency, and technology-enabled tools to support adherence and disease management. We examine how biologics, regenerative and gene-based approaches, nanomedicine platforms, and digital health interventions are reshaping asthma care, while critically appraising their clinical maturity and implementation challenges. RECENT

findingsAdvances in precision therapy have substantially improved outcomes for patients with severe asthma, particularly through biologics targeting IgE, IL-5 or its receptor, IL-4/IL-13 signalling, and the upstream epithelial alarmin thymic stromal lymphopoietin. These agents consistently reduce exacerbation frequency and systemic corticosteroid use in selected populations, with favourable short- to medium-term safety profiles. In contrast, regenerative strategies such as mesenchymal stem cell–based therapies, gene-based interventions including miRNA and siRNA modulation, and tolerogenic mRNA vaccines remain largely preclinical, offering mechanistic insight but limited clinical readiness. Nanoparticle-enabled drug delivery systems show potential to enhance pulmonary targeting and controlled release, though evidence is predominantly experimental. In parallel, smart inhalers, digital therapeutics, and environmental monitoring technologies address behavioural and environmental determinants of asthma control by improving adherence, inhaler technique, and trigger identification. However, their real-world impact is constrained by cost, integration into clinical workflows, and limited long-term effectiveness data. Asthma management is increasingly moving toward precision, endotype-informed care supported by targeted biologics, advanced delivery systems, and digital self-management tools. While biologics represent the most clinically established advances, regenerative, gene-based, and nanomedicine approaches remain exploratory and require robust long-term evaluation. Key priorities for future research include effective therapies for non–Type 2 and steroid-resistant asthma, improved affordability and equitable access, and integrated care models that combine biomarkers with adherence and environmental monitoring to optimise sustained disease control.